139 Chal Smith Rd , v�/
DavieNC Tax Po�� ��~TA � �� Monday, September 26, 2016
WARNING: 139
141.7
THIS IS NOT A SURVEY
Parcel-Infonnation
Parcel Number: F600000004 Township: Farmington
NCP|NNumher 5850269556 Municipality:
Account Number: 70588000 Census Tract: 37059'803
Listed Owner 1: QTALEYLARRY JAMES Voting Precinct: SMITH GROVE
Mailing Address 1: 154CHALSMITH ROAD Planning Jurisdiction: Davie County
City/ W1OCKGV|LLE Zoning Class: D/VV|ECOUNTY R+\.R' O
State: NC Zoning Overlay: D/v/|ECOUNTY OD
-
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 1LOT CHALSMITH RD Fire Response District: SMITH GROVE
Aooeomwd Acreage: 0.47 Elementary School Zone: P|NEBROOK
Deed Date: 11/2008 Middle School Zone: NORTHD/VV|E
Deed Book/Page: 007760171 Soil Types: En8.EnC
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: D/A/ECOVNTY
�
Building Value: 23980.00 FeabureoOutbuilding~Extra
360.00
Land Value: 14180.00 Total Market Value: 38500l0
Total Assessed Value: 3850000
Vol
Permittee'sr-�, DAVIE COUNTY HEALTH DEPARTMENT
NamEnvironmental Health Section PROPERTY INFORMATION
' " Q P.O.Box 848
Directions to property: Mocksville,NC 27028 Subdivision Name:
r-1 g�" {{OL Phone#: 336-751-8760
I Ti (itvSection: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION —z--
AUTHORIZATION NO: �" 1 A Road Name c �. - f: °"� ip: �S
�p .a >
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Off�e whey applying for Building Permits.
(In complian 6,with Arlicle }1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
RET�Al_
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/W IS VALID FOR A PERIOD OF FIVE YEARS.
_ENVCROHEALTH SPE&tIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE n4 #BEDROOMS �' #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS' INDUSTRIAL WASTE:Yeses or No
LOT SIZE /�`�`�STYPE WATER SUPPLY � �,. DESIGN WASTEWATER FLOW(GPD) Y�� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
OTHER t"l 1 1 tsS
REQUIRED SITE MODIFICATIONS/CONDITIONS:
A 1.cS
IMPROVEMENT PERMIT LAYOUT
R
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2 �o cr-rt�-S
. �,. ,4 2 3
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT .
SYSTEM INSTALLED BY:
y
X12-4 o
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABO HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900."SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION ?S-12920
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) /-�
NAME lLxt�� �wast5 .
PHONE NUMBER ;4{0 T& �9gS3
ADDRESS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE L
DATE SYSTEM INSTALLED 7'3NOs NAME SYSTEM I�N5r, L -�D UN ER
Com' � 06V�90 ori' s,.�J RX11 `r k rte. (
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY La&L_ SPECIFY PROBLEM OCCURRING
DATE REQUESTEDINFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am reonsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193